Tension Headaches

Covers causes and symptoms of tension headaches. Looks at managing headaches with over-the-counter and prescription medicines. Includes stress reduction and getting sleep and exercise. Includes getting treatment for depression or anxiety.

Covers causes and symptoms of tension headaches. Looks at managing headaches with over-the-counter and prescription medicines. Includes stress reduction and getting sleep and exercise. Includes getting treatment for depression or anxiety.

What is a tension headache?

Most headaches are
tension headaches. These headaches tend to happen again and again, especially
if you are under stress. They are not usually a sign of something serious. But
they can be very painful and hard to live with.

Tension headaches can last
from 30 minutes to 7 days.

If you have a headache on 15
or more days each month over a 3-month period, you may have
chronic tension headaches. This
type of headache can lead to
stress and
depression, which in turn can lead to
more headaches.

About 4 out of every
100 people in Canada get chronic tension
headaches.1 Symptoms can start in childhood, but they
are more likely to occur during middle age.

What causes tension headaches?

Doctors don't know
for sure what causes tension headaches. Experts once thought that tension or
spasms in the muscles of the neck, face, and head played a
role. Now they think that a change in brain chemicals also may be a
cause.

Tension headaches are one of the most common types
of headaches. They can be brought on—or
triggered—by things such as stress,
depression, hunger, and
muscle strain. Tension headaches may come on suddenly
or slowly.

What are the symptoms?

Symptoms of tension
headaches include:

A headache that is constant, not throbbing.
You usually feel the pain or pressure on both sides of your
head.

Pressure that makes you feel like your head is in a vise.

Aching pain at your temples or the back of your head and neck.

This is different than
migraine headaches, which usually cause throbbing pain
and start on one side of your head.

Tension headaches tend to come
back, especially when you are under stress.

Pain from a tension headache is
usually not severe and does not get in the way of your
work or social life. But for some people, the pain is very bad or lasts a long
time.

How are tension headaches diagnosed?

A doctor can
usually diagnose tension headaches by asking you questions about your health
and lifestyle and by examining you.

How are they treated?

Most people can treat their
tension headaches with
over-the-counter pain relievers
like acetaminophen (such as Tylenol) or aspirin.

But if you take
these pain relievers more than 3 times a week, you may get
rebound headaches. These are
different from tension headaches. Rebound headaches usually start after pain
medicine has worn off, which leads you to take another dose. After a
while, you get a headache whenever you stop taking the medicine.

Your doctor may prescribe medicine if
you get chronic tension headaches.

Can you prevent tension headaches?

Even with treatment, most people still have some headaches. But with
treatment, you will probably have them less often. And when you do get them,
they probably won't be as bad.

Home treatment may help you avoid headaches. You can:

Try to reduce stress.

Make sure you sleep, exercise, and eat on a regular
schedule.

Make sure you practice good posture. Stand and sit up
straight.

Try not to strain
your eyes when you use your computer.

Get treatment for depression
or anxiety if you have those health problems.

Try using a headache diary. Every time you get a headache, write down the date, the time, and what
you were doing and feeling before your headache started. This may help you and
your doctor find out what is causing your headaches. Then your doctor can use
the diary to plan your treatment.

Cause

The cause of
tension headaches is not clear. In the past, doctors
believed that tension or spasms of the muscles of the neck, face, jaw, head, or
scalp played a role in causing these headaches. Now they think a change in
brain chemistry may also help cause a tension headache.

Tension headaches are the
most common type of headache. They can be
brought on—or
triggered—by things such as stress,
depression, hunger, and
muscle strain. Tension headaches may come on suddenly
or slowly.

Chronic tension headaches often
occur along with other health problems such as
anxiety or
depression.

Symptoms

Symptoms of
tension headaches include:

A constant headache that does not throb or
pulse. You usually feel the pain or pressure on both sides of your
head.

Tightness around your forehead that may feel like a "vise
grip."

Aching pain at your temples or the back of your head and
neck.

Unlike
migraines, tension headaches usually don't occur with
nausea, vomiting, or feeling sensitive to both light and
noise. But light or noise could make your headache worse.
Tension headaches usually aren't bad enough to keep you from doing your daily
activities.

Your life is disrupted by your
headaches (for example, you miss work or school regularly).

Watchful waiting

Watchful waiting is a wait-and-see
approach. If your headache gets better on its own, you won't need treatment. If
it gets worse or you get headaches often, you and your
doctor will decide what to do next.

Watchful waiting and using
over-the-counter pain medicines work well if
your tension headaches don't keep you from doing
the things you want to do. But if your headaches are
disrupting your life, talk to your doctor about other treatments that you could
try.

Examinations and Tests

Finding out the type of headache you have

A doctor can
usually diagnose
tension headaches by asking you
questions about your health and lifestyle
and by examining you.

It can be hard to know which
type of headache you have, because different types can have the same symptoms. But the treatments may be different, so it's important to find out which type you have.

Finding other possible causes

In very rare cases, headaches can be caused by more
serious health problems (such as
brain tumours or
aneurysms). But most headaches aren't caused
by anything serious, so you probably won't need to have tests.

Over-the-counter medicines to stop
headaches

Medicines can help you feel better. But they can also be dangerous, especially if you don't take them the right way. Be safe with medicines. Read and follow all instructions on the label.

Try these drugs first. Most doctors recommend that you try over-the-counter drugs first
if you have mild to moderate headaches. They may have fewer side effects than
prescription drugs. These medicines include:

Medicine that combines aspirin, acetaminophen, and
caffeine, such as Excedrin.

Don't take this medicine too often. Try not to take over-the-counter drugs more than 3 times a week,
because you may get
rebound headaches. These are different from tension
headaches. They are usually triggered after pain medicine has worn off,
prompting you to take another dose. After a while, you get a headache whenever
you stop taking the medicine.

Prescription medicines to stop
headaches

In some cases, your doctor may
prescribe stronger medicine if over-the-counter drugs don't stop your
headaches. These medicines may include
barbiturates or
narcotics. But these drugs can be
habit-forming, so they should be used rarely and only for a short
time.

Prescription medicines to prevent
headaches

You may want to try medicine to prevent a headache
if:

You are using medicines to stop headaches
more than 3 times a week.

Medicines to stop headaches aren't
working well for you.

Your doctor may have you try one or more
medicines, such as an antidepressant or a medicine that prevents seizures.
These medicines can help prevent headaches even if you don't have
depression or
seizures.

Avoiding triggers

You may be
able to prevent or reduce tension headaches by learning what causes your
headaches and trying to avoid those
triggers. For more information, see
Living With Tension Headaches.

Reducing stress

How
you think can affect how you feel. So finding ways to relax and stop negative thoughts may help prevent headaches.

Treatment if headaches get worse

If you continue to have
tension headaches while you are getting treatment, you
and your doctor may want to try another treatment.

You
may have to try different drugs or doses.
If you have already tried several medicines, your doctor may order
tests (such as an
MRI or
CT scan) to find out if a health problem is
causing your headaches.

Other things to think about

Even with treatment, you will most likely
still get some tension headaches. But you
probably will get them less often. And they may hurt less when you do get
them.

If you also have
depression or
anxiety, talk to your doctor. Treatment for these
health problems also may help you have fewer headaches.

Prevention

Finding and avoiding the
things—or triggers—that lead to
tension headaches can reduce how often you get
headaches and how bad they are when you do get them.

Using a
headache diary(What is a PDF document?) can help you find your triggers. You write down when you have a
headache and how bad it is, along with details such as what you ate and what
you were doing before the headache started. This information can help you avoid
things that bring on your headaches. And the diary also can help your doctor
plan your treatment.

If you have headaches caused by muscle
tension in your neck, shoulders, and upper back, pay attention to your posture
during your daily activities. You also can try muscle relaxation and other ways to reduce muscle tension.

Your doctor also may
prescribe medicine to help prevent tension headaches.

Living With Tension Headaches

You may have fewer headaches—and less pain when you do get
them—if you:

Find and avoid triggers

Use a headache diary

Use a
headache diary(What is a PDF document?) to find your triggers. You write down when you have a headache
and how bad it is, along with details such as what you ate and what you were
doing when the headache started. This information can help you avoid things
that bring on your headaches. A diary also may help your doctor plan your
treatment.

Take medicines as your doctor
advises

If you have mild to moderate
headaches, your doctor probably will want you to take
over-the-counter medicines to stop your headaches.
These include medicines like acetaminophen (such as Tylenol) and ibuprofen
(such as Motrin). Be safe with medicines. Read
and follow all instructions on the label.

If over-the-counter
medicines don't stop your headaches well enough—or you get a lot of
headaches—your doctor may prescribe medicine to prevent
headaches.

Don't take medicine too often. Talk to your doctor if you're taking medicine more than 3
days a week to stop a headache, or if you have a headache on more than 15 days
a month. Taking too much over-the-counter pain medicine can lead to more
headaches. These are called
rebound headaches.

Reduce stress

One Man's Story:

Jerry, 32

"I hold my stress in my shoulders and neck. My shoulders
are always up around my ears. A lot of times, I leave at the end of the day
with a big headache."—Jerry

You can lower your stress with
positive thinking and relaxation methods. Research shows that you can change how
you think. And how you think affects how you feel. Try these techniques on your own or
with help from a therapist or counsellor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioural therapy.

Medications

You might
only need to take an
over-the-counter medicine for pain. These medicines
usually have fewer side effects than prescription drugs. Always be safe with medicines. Read
and follow all instructions on the label.

Over-the-counter drugs to stop
headaches

Over-the-counter medicines that you
can use to stop a headache include:

Acetaminophen (such as
Tylenol).

Aspirin.

Ibuprofen
(such as Advil).

Naproxen (such as
Aleve).

Medicine that combines aspirin,
acetaminophen, and caffeine (such as Excedrin).

Try to avoid taking over-the-counter drugs more
than 3 times a week, because you may get
rebound headaches. These are different from tension
headaches. They usually occur after headache medicine has worn off. This leads you to take another dose. After a while, you get a headache whenever you stop
taking the medicine.

Prescription drugs to stop
headaches

In some cases your doctor may
prescribe a medicine such as a
barbiturate or
narcotic to stop a headache if non-prescription
medicines don't work. But these drugs can be habit-forming and
should be used rarely and only for a short time.

Prescription drugs to prevent
headaches

Your doctor may recommend that you
take a prescription medicine every day to prevent headaches. You may want to take this medicine
if:

Botulinum toxin type A (BTX-A) is sometimes injected into
the muscles in the face and head to treat headaches.
In the past, doctors thought that spasms caused tension
headaches. But BTX-A injections do not seem to help with symptoms of tension
headaches.1, 2 And BTX-A may
cause weakness of the facial muscles and may make it hard for you to
swallow.

The medicine that you take may cause side effects. Some side effects may last for a few weeks or for as long as you take the medicine.

You may have to try
several different drugs or types of drugs before you find the one that is right
for you. Make sure to tell your doctor how well a drug stops your
headaches.

Certain pain medicines can cause a
bad reaction if you take them with other medicines. Before you begin
taking pain medicines, be sure to let your doctor know about all of the drugs
you take. This includes over-the-counter medicines and
complementary treatments (such as herbs).

Other Treatment

Using other treatments
along with medicines may help you stop a
tension headache or prevent one.

If you decide to try one or more of these treatments, make sure your doctor knows. He or she may have advice on how to use other treatments safely. Other treatments for headaches include:

Acupuncture. This
involves putting very thin needles into the skin at certain points on the body.
Studies show that acupuncture can help prevent tension
headaches.3

Biofeedback.
This is a relaxation method to help you learn to control a
body function that you normally don't control, such as
muscle tension.

FIND Services and Resources

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty and all liability in connection with your use of this information. Distributed and adapted by Ministry of Health, Province of British Columbia with permission from Healthwise, Incorporated. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Is it an emergency?

If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be life-threatening. Call 9-1-1 or the local emergency number immediately. If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.